Insurance Guidelines for Gender Confirmation Care Updated in 2024

NEWS RELEASE
COLORADO DEPARTMENT OF REGULATORY AGENCIES
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In 2023, Colorado became the first state in the nation to explicitly include gender-affirming care services in essential health insurance plans (EHBs). To better understand the new requirements, the Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has created guidance on gender-affirmation care (GAC) medical services coverage for individual and small group health insurance. plans.

DOI has updated the guidance to reflect insurance companies and plans that will be available in 2024 in light of current open enrollment.

2024 Colorado Department of Insurance Gender Confirmation Care Coverage Guide

Each health insurance plan covers different services, which can be difficult for transgender and non-binary people seeking medically necessary services or hormone therapies as part of their individual treatment plans. The GAC Coverage Guide provides a simple way to find coverage answers. And since we’re in the midst of annual open enrollment for individual coverage (for people who don’t get coverage from an employer), it can also help people choose coverage plans in 2024.

Please note that the information in this guide is not an exhaustive list of all gender affirming care procedures, but rather a list of many common gender dysphoria treatment services. It also does not include various processes, such as prior authorization or provider letters, that may be required by an insurance company to demonstrate that a service or medication is medically necessary.

The benchmark plan defines EHBs for commercial plans in the Colorado area, meaning individual health insurance plans (non-employer plans) and small group plans (employers with fewer than 100 employees). required cover these services. The Centers for Medicare and Medicaid Services (CMS) approved Colorado’s new benchmark plan in October 2021, which then went into effect in 2023.

Gender-affirming health care is an important part of the health care services that every transgender person deserves to achieve their own well-being, and it is not a one-size-fits-all health care solution. Colorado has many protections in place to ensure access to medically necessary gender-affirming care and non-discrimination in health care based on gender identity.

LGBTQ health insurance coverage rights in Colorado

Colorado Insurance Regulation 4-2-62 prohibits discrimination in private health insurance plans based on sexual orientation or gender identity. Private insurance plans* sold in Colorado and regulated by the Colorado Department of Insurance cannot do the following.

• Ask about the applicant’s or beneficiary’s sexual orientation or gender identity on the insurance application
• Deny, cancel, limit or refuse to issue or renew a policy because of a person’s sexual orientation or gender identity
• Deny, exclude, or otherwise limit coverage for medically necessary services consistent with generally accepted professional standards of care based on a person’s sexual orientation or gender identity.

*If your health plan ID card has “CO-DOI,” your plan is regulated by the Colorado Division of Insurance and is subject to Colorado insurance laws and regulations.

Find more information on our website: LGBTQ Health Care Rights and Resources.

People with questions about their health insurance coverage can contact Insurance Consumer Services at 303-894-7490 / [email protected] / doi.colorado.gov (click “File a Complaint”).

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